Utah doctors group blasts out recommendation on treating coronavirus, then swiftly reverses it

Editor’s note: The Salt Lake Tribune is providing readers free access to critical local stories about the coronavirus during this time of heightened concern. See more coverage here. To support journalism like this, please consider donating or become a subscriber.

Utah’s largest physicians network on Friday disseminated a recommendation — purportedly from state health officials — that doctors prescribe an unproven malaria medication for coronavirus, then rescinded it a day later amid pushback from infectious disease specialists.

In retracting its initial message, the Utah Medical Association (UMA) acknowledged a “lack of convincing evidence” that the medications help COVID-19 patients and explained that the few available studies are of poor quality and conflict with one another. And the drugs come with their own set of risks, the medical group explained.

The original advisory, sent out on behalf of the Utah Department of Health, told UMA members that the medication was “showing some promising data for affecting the course of COVID-19″ and said state health officials were recommending its use.

Michelle McOmber, CEO of the Utah Medical Association, refused to describe the conversations that took place between her group and state health officials before Saturday’s about-face.

“Realize that things are changing rapidly in this area,” she said in an interview. “Extremely rapidly, could be changing hourly, daily, even minute by minute.”

She then attempted to rescind her on-the-record comments and instead supply a written statement that said the organization is doing its best to share the latest information with medical providers.

A spokesman for the Utah Department of Health said his agency never intended to advise physicians to use the medications, hydroxychloroquine and chloroquine, but only to circulate dosage guidelines for doctors who did want to prescribe the drugs to coronavirus patients. He chalked up UMA’s initial message to a miscommunication between the organization and state health officials.

The Food and Drug Administration on Sunday announced an emergency authorization to allow use of the drugs in treatment of the coronavirus, but warned that “clinical trials are needed to provide scientific evidence that these treatments are effective.”

The state’s site says providers “may explain to patients that there have been some small, preliminary studies” suggesting that hydroxychloroquine or chloroquine could help prevent lung complications.

Nausea, vomiting, diarrhea and abdominal pain are the most common side effects, but patients might also experience dizziness, headaches, anxiety, lack of appetite and skin or hair discoloration, according to the health department.

The drugs do not prevent someone from contracting the disease, the state officials warned.

Like many aspects of the pandemic, the medications have become politicized, touted by Fox News personalities and hyped by President Donald Trump as a potential “game-changer." In Utah, a state task force held a press conference in which an occupational health physician said the drugs were bringing coronavirus patients back from the brink of death, likening the transformation to the resurrection of Lazarus.

On Sunday, the Food and Drug Administration gave emergency approval to a Trump administration plan to get the drugs to COVID-19 patients in hospitals across the country.

Meanwhile, the nation’s top infectious disease expert has cautioned that signs of the drugs’ promise against the coronavirus are anecdotal, with no controlled clinical trial on their efficacy against the disease. Experts in Utah have also warned against jumping to conclusions.

Still, sudden demand for the drugs is creating shortages for patients who have long used them to treat autoimmune disorders such as lupus, according to ProPublica.

Dr. Andrew Pavia, chief of pediatric infectious diseases at University of Utah Health, said more than 50 infectious disease physicians and pharmacists at the U. and Intermountain Healthcare helped inform state health officials and UMA about the latest science on hydroxychloroquine and the potential risks of using it in coronavirus cases.

“Even if they prove helpful, people should understand they are not miracle drugs. Like all medicines, they have real side effects that can even be life threatening,” Pavia wrote in an email. “Too often drugs that have seemed helpful based on stories and anecdotes have been widely adopted, only to find when properly studied that they were useless or even harmful.”

But that doesn’t mean Utahns with coronavirus won’t have any access to the medication.

Medical societies recommend that unproven drugs be used within the context of a clinical trial, the UMA wrote, and state health groups are trying to launch a couple such studies in Utah. Intermountain and U. Health are collaborating to test the impact of hydroxychloroquine in hospitalized coronavirus patients and will also look for adverse side effects in outpatient cases, the email stated.

“Providing these therapies to patients within a trial framework is consistent with professional obligations as licensed prescribers to balance access to possible treatments with patient safety,” the email stated.

Dr. Sankar Swaminathan, chief of infectious diseases at the U. Health, said specialists at the U. have been administering hydroxychloroquine to coronavirus patients in select cases, when the person’s condition was deteriorating and there were no high risk factors for side effects.

“[W]e have used it with the understanding that this is not proven therapy," he said, adding that they might use it in hopes of keeping the patient off of a ventilator.

And Pavia said providers do hope the drugs will “prove useful in the fight against COVID-19” but expressed the urgent need for solid information so doctors can avoid needlessly exposing patients to medications that do no good.

State Rep. Suzanne Harrison, D-Draper and a physician, praised the testing efforts.

“We know that quality studies are lacking regarding these medications, and I’m encouraged that the U of U and Intermountain are working together to set up a quality medical study,” Harrison said.

“I’m grateful to the patients, physicians and scientists who will help us get definitive answers about whether these medications are helpful in fighting COVID-19. It is important to find evidence-based treatments to help and protect patients. The only way to find real answers is by conducting clinical studies.”

Harrison said she hopes “we will soon have effective treatments that will save lives.”

— Tribune columnist Robert Gehrke contributed to this report.